Slow start for ambitious state Medicaid initiative

ALBANY—One of the state’s most ambitious initiatives to reform its Medicaid program and improve care for its costliest patients has enrolled just a few hundred people during its first two months of operation, while nearly 30,000 people have opted out of the program, the state health department said.

The Fully Integrated Duals Advantage program (FIDA), approved by the federal Centers for Medicare and Medicaid Services in 2013, is a demonstration program that is enrolling downstate New Yorkers who receive both Medicaid and Medicare into a managed long-term care plan.

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The upside for these so-called "dual eligible" patients is that they would be contracting with a single insurance plan to cover all of their medical care instead of using both managed long-term care plans for some services and Medicare for the primary care visits.

A handful of other states, including California and Massachusetts, are also experimenting with FIDA programs as part of the federal government's attempt to explore new ways to control costs and better coordinate care for dual eligibles, who are among states' costliest patients.

Approximately 700,000 dual eligibles in New York State account for roughly 37 percent of Medicare spending and 45 percent of Medicaid spending, or about $36 billion a year, according to a 2012 report by the United Hospital Fund’s Medicaid Institute. Approximately 135,000 "dual eligible" patients enrolled in managed long-term care in New York are eligible for the FIDA program in the state.

The state health department began enrolling "dual eligibles" on Jan. 1, starting with people who live in New York City and in Nassau County. But so far, far more people have chosen to opt out than have elected to participate.

“There are currently 765 individuals who have opted in and 27,932 individuals who have opted out,” a health department spokesperson told Capital in an email. “This is comparable to what other states participating in the demonstration have experienced. Approximately 70 percent of the eligible population has not made a decision on enrollment yet.”

State health officials said it is too soon to gauge the program's viability.

Though the program is voluntary, the state will begin "passive enrollment" of all dual-eligibles in New York City and Nassau County on April 1. It will allow anyone to opt out if they are worried about losing continuity of care with their current physician.

The second phase of the FIDA enrollment program, for people living in Suffolk and Westchester counties, was to begin April 1, but is being delayed. The health department said late last week that it and the federal Centers for Medicare and Medicaid Services “are temporarily pausing” the implementation of FIDA in Suffolk and Westchester “due to network deficiencies.”

The FIDA program has been controversial among some health care providers and patient advocacy groups who say they’re concerned about patients’ ability to drop out of the program if they are not satisfied and about patients' ability to maintain their regular doctors.

“We are still in the first phase of the launch of the program. We anticipate that enrollments will increase every month. Call volume suggests that recipients and their caregivers are carefully considering their options,” the state health department said in a statement to Capital. “The Department is committed to the fully integrated program and will continue to work with all stakeholders to increase enrollment numbers while also focusing on the quality of the patient experience for those already enrolled.”

For people who are already enrolled, early reports suggest FIDA is working well, allowing doctors to coordinate care in a way they’ve never been able to before, said Krystal Scott, New York state policy director at the Medicare Rights Center.

“People who are currently enrolled are, as far as we’ve heard, able to access services, which is great,” Scott said.